Provider Demographics
NPI:1760140347
Name:FAR WEST IMAGING LP
Entity Type:Organization
Organization Name:FAR WEST IMAGING LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-299-7600
Mailing Address - Street 1:3742 FAR WEST BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3044
Mailing Address - Country:US
Mailing Address - Phone:512-373-3615
Mailing Address - Fax:512-373-3452
Practice Address - Street 1:3742 FAR WEST BLVD STE 109
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3044
Practice Address - Country:US
Practice Address - Phone:512-373-3615
Practice Address - Fax:512-373-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty